Cesarean Sections (C-Sections)

Every pregnant woman hopes for a short labor and delivery with no complications
— manageable contractions, some pushing, then a beautiful baby.

But it doesn't always work out that way. Some babies need to be delivered via cesarean
section (C-section).

Even if you're hoping for a traditional vaginal birth, it may help to ease some
fears to learn why and how C-sections are performed, just in case everything doesn't
go as planned.

What Is a C-Section?

A C-section is the surgical delivery of a baby that involves making incisions in
the mother's abdominal wall and uterus. Generally considered safe, C-sections do have
more risks than vaginal births. Plus, moms can go home sooner and recover quicker
after a vaginal delivery.

But C-sections can help women who are at risk for complications avoid dangerous
delivery-room situations and can be a lifesaver in an emergency.

C-sections are done by obstetricians (doctors who care for pregnant women before,
during, and after birth) and some family physicians. Although more and more women
are choosing midwives to deliver their babies, midwives of any licensing degree cannot
perform C-sections.

Why Are C-Sections Needed?

Scheduled C-Sections

Some C-sections are scheduled if the doctor knows that a vaginal birth would be
risky. A doctor may schedule one if:

the baby is in breech (feet- or bottom-first) or transverse (sideways) position
in the womb (although some babies can be turned before labor begins or delivered vaginally
using special techniques)

the baby has certain birth defects (such as severe hydrocephalus)

the mother has problems with the placenta, such as placenta previa (when the placenta
sits too low in the uterus and covers the cervix)

the mother has a medical condition that could make a vaginal delivery risky for
herself or the baby (such as HIV or an active case of genital herpes)

some multiple pregnancies

the mother previously had surgery on her uterus or an earlier C-section (although
many such women can safely have a vaginal birth after a C-section, called a
VBAC)

Emergency C-Sections

Some C-sections are unexpected emergency deliveries done when complications arise
with the mother and/or baby during pregnancy or labor. An emergency C-section might
be done if:

labor stops or isn't progressing as it should (and medicines aren't helping)

the baby is in fetal distress — certain changes in the baby's heart rate
may mean that the baby is not getting enough oxygen

the baby's head or entire body is too big to fit through the birth canal

Of course, each woman's pregnancy and delivery is different. If your doctor has
recommended a C-section and it's not an emergency, you can ask for a second opinion.
In the end, you most often need to rely on the judgment of the doctors.

How Is a C-Section Done?

Here's a quick look at what usually happens during a scheduled C-section.

Your labor coach, wearing a surgical mask and gown, can be right by your side during
the entire delivery (although partners might not be allowed to stay during emergency
C-sections). Before the procedure begins, an anesthesiologist will discuss what will
be done so that you don't feel pain during the C-section.

To prepare for the delivery, you'll probably have:

various monitors in place to keep an eye on your heart rate, breathing, and blood
pressure

your mouth and nose covered with an oxygen mask or a tube placed in your nostrils
to give you oxygen

a catheter (a thin tube) inserted into your bladder through your urethra (which
may be uncomfortable when it's placed, but should not be painful)

an IV in your arm or hand

your belly washed and any hair between the bellybutton and pubic bone shaved

a privacy screen put around your belly

After anesthesia is given, the doctor makes an incision on the skin of the abdomen
— usually horizontally (1–2 inches above the pubic hairline, sometimes
called "the bikini cut").

The doctor then gently parts the abdominal muscles to get to the uterus, where
he or she will make another incision in the uterus itself. This incision can be vertical
or horizontal. Doctors usually use a horizontal incision in the uterus, also called
transverse, which heals better and makes a VBAC much more possible.

After the uterine incision is made, the baby is gently pulled out. The doctor suctions
the baby's mouth and nose, then clamps and cuts the umbilical cord. As with a vaginal
birth, you should be able to see your baby right away. Then, the little one is handed
over to the nurse or doctor who will be taking care of your newborn for a few minutes
(or longer, if there are concerns).

The obstetrician then removes the placenta from the uterus, closes the uterus with
dissolvable stitches, and closes the abdominal incision with stitches or surgical
staples that are usually removed, painlessly, a few days later.

If the baby is doing OK, you can hold and/or nurse your newborn in the recovery
room. You may need help holding the baby on the breast if you have to stay lying down
flat.

Will I Feel Anything?

You won't feel any pain during the C-section, although you may feel sensations
like pulling and pressure. Most women are awake and simply numbed from the waist down
using regional anesthesia (an epidural and/or a spinal block) during a C-section.

That way, they are awake to see and hear their baby being born. A curtain
will be over your abdomen during the surgery, but you may be able to take a peek as
your baby is being delivered from your belly.

Sometimes, a woman who needs an emergency C-section might require general anesthesia,
so she'll be unconscious (or "asleep") during the delivery and won't remember anything
or feel any pain.

What Are the Risks?

C-sections today are, in general, safe for both mother and baby. However, there
are risks with any kind of surgery. Potential C-section risks include:

Some of the regional anesthetic used during a C-section does reach the baby, but
it's much less than what the newborn would get if the mother had general anesthesia
(which sedates the baby as well as the mother).

Babies born by C-section sometimes have breathing problems (transient
tachypnea of the newborn) because labor hasn't jump-started the clearance of fluid
from their lungs. This usually gets better on its own within the first day or two
of life.

Having a C-section may — or may not — affect future pregnancies and
deliveries. Many women can have a successful and safe vaginal birth after cesarean.
But in some cases, future births may have to be C-sections, especially if the incision
on the uterus was vertical rather than horizontal. A C-section can also put a woman
at increased risk of possible problems with the placenta in future pregnancies.

In the case of emergency C-sections, the benefits usually far outweigh the risks.
A C-section could be lifesaving.

What Is the Recovery Like?

As with any surgery, there's usually some degree of pain and discomfort after a
C-section. The recovery period is also a little longer than for vaginal births. Women
who've had C-sections usually stay in the hospital for about 3 or 4 days.

Right after, you may feel itchy, sick to your stomach, and sore — these are
all normal reactions to the anesthesia and surgery. If you needed general anesthesia
for an emergency C-section, you may feel groggy, confused, chilly, scared, alarmed,
or even sad. Your health care provider can give you medicines to ease any discomfort
or pain.

For the first few days and even weeks, you might:

feel tired

have soreness around the incision (the doctor can prescribe medicines and/or recommend
over-the-counter pain relievers that are safe to take if you're breastfeeding)

be constipated and gassy

have a hard time getting around and/or lifting your baby

It can help if you support your abdomen near the incision when you sneeze, cough,
or laugh. These sudden movements can be painful. You'll need to avoid driving or lifting
anything heavy so that you don't put any unnecessary pressure on your incision.

Check with your health care provider about when you can get back to your normal
activities (typically after about 6 to 8 weeks, when the uterus has healed). As with
a vaginal delivery, you shouldn't have sex until your doctor has given you the go-ahead,
usually about 6 weeks after delivery.

Frequent and early walking may help ease some post-cesarean pains and discomfort.
It also can help prevent blood clots and keep your bowels moving. But don't push yourself
— take it easy and have someone help you get around, especially up and down
stairs. Let friends, family, and neighbors lend a helping hand with meals and housework
for a while, especially if you have other children.

Although breastfeeding might be a little painful at first, lying on your side to
nurse or using the clutch (or football) hold can take the pressure off your abdomen.
Drink plenty of water to help with your milk supply and to help avoid constipation.

C-sections scars fade over time. They'll get smaller and become a natural skin
color in the weeks and months after delivery. And because incisions are often made
in the "bikini" area, many C-section scars aren't even noticeable.

What If I Don't Feel Better?

pain around your incision or in your abdomen that comes on suddenly or gets worse

foul-smelling vaginal discharge

pain when peeing

trouble pooping

heavy vaginal bleeding

leg pains, or swelling or redness of your legs

trouble breathing or chest pain

pain in one or both breasts

feelings of depression

thoughts of hurting yourself or your baby

Emotionally, you may feel a little disappointed if you'd been hoping for a vaginal
birth or had gone through labor that ended in a C-section. Remember that having a
C-section does not make the birth of your baby any less special or your efforts any
less amazing. After all, you went through major surgery to deliver your baby!